Infectious disease
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan in Essential Notes for Medical and Surgical Finals, 2021
Most patients who present with a fever lasting for >1–2 weeks will usually have received a diagnosis for their illness. However, rarely it remains unexplained and is known as a fever or pyrexia of unknown origin (FUO or PUO). PUO can be grouped according to cause: infection (e.g. endocarditis, osteomyelitis, TB, HIV)inflammation (e.g. autoimmune disorders such as SLE, vasculitis)malignancy (particularly haematological malignancies)drug-induced (e.g. antibiotics)factitious (rare). A detailed history is important (including travel, occupational, pets or other animal contact, hobbies). Examination also has to be detailed. Investigations are guided by the history and the examination but include serological blood tests, imaging and echocardiography.
Pathophysiology of Fever
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
The cornerstone of the new era was the introduction of the clinical thermometer, which permitted the measurement of patient’s body temperature to become routine.2 However, this major development failed to bring with it the solution to the question of whether fever is advantageous or disadvantageous to the host. Fever represents a regulated increase in body temperature, usually not exceeding 41.1°C in humans. In contrast, the temperature in malignant hyperthermia or heat stroke may rise to higher, lethal levels.3 Early studies did not demonstrate a positive role for fever.4 In fact, even normal body temperature has a circadian rhythm, with a maximum level in the late afternoon and a gradual fall to the minimum in the morning. Various factors such as environmental temperature changes, exercise, or menstrual cycle can influence normal temperature.5
Mobilization and Conditioning Regimens in Stem Cell Transplant for Autoimmune Diseases
Richard K. Burt, Alberto M. Marmont in Stem Cell Therapy for Autoimmune Disease, 2019
Fever may cause exacerbation of neurologic deficits in patients with multiple sclerosis, a phenomenon termed pseudo-exacerbation. Therefore, infections and drugs that cause fever should be avoided. An engraftment syndrome of fever, rash, and fatigue with exacerbation of symptoms has been described in MS and is treated by a short course of peri-engraftment oral corticosteroids.60 Finally, when HSCT regimens were first designed, MS was recognized to be an immune-mediated demyelinating disease. Since then, MS has been recognized to be both an immune-mediated demyelineating disease and an axonal degenerative process. This raised questions about TBI or radiation inducing axonal injury and/or TBI-related inhibition of CNS repair by neural stem cells or oligodendrocyte progenitors. Future conditioning regimens should be designed towards immune suppression while minimizing risks of further axonal injury. Future studies will probably focus on patients with less disability and relapsing disease (refer to Chapter 37). Such patients have a five-year MS-related mortality of virtually zero. It will, therefore, be important to utilize safer conditioning regimens.
Current status of 4-aminoquinoline resistance markers 18 years after cessation of chloroquine use for the treatment of uncomplicated falciparum malaria in the littoral coastline region of Cameroon
Published in Pathogens and Global Health, 2022
Marcel Nyuylam Moyeh, Sandra Noukimi Fankem, Innocent Mbulli Ali, Denis Sofeu, Sorelle Mekachie Sandie, Dieudonne Lemuh Njimoh, Stephen Mbigha Ghogomu, Helen Kuokuo Kimbi, Wilfred Fon Mbacham
A total of 456 participants were screened in both towns for the presence of the malaria parasite by light microscopy. Samples/data was collected from only 240 participants (52.6%) that were shown to be parasite positive by microscopy. Of the 240 participants retained for the study, 58.8% (141/240) were females while 41.2% (99/240) were males. The proportion of females was significantly higher when compared to that of males (P = 0.0002). The participants’ ages ranged from 1–70 years with a mean age of 25.6 ± 18.9. Fever defined as temperature above or equal to 37.5°C was observed in 43.3% (104/240) of participants, and the temperature ranged from 36.0°C to 40.0°C [Median: 37.8°C, (25th percentile: 37°C; 75th percentile: 38°C)]. Asexual parasitemia detected by light microscopy ranged from 40 to 156,000 parasites/µl of blood.
Elderly Hospitalized for COVID-19 and Fever: A Retrospective Cohort Study
Published in Experimental Aging Research, 2022
Noel Roig-Marín, Pablo Roig-Rico
Fever is a protective response against infection. For this reason, it is reported in multiple recently published case reports (Becerra-Lemus, Rincón-Herrera, Restrepo-Vanegas, & Vargas-Rodríguez, 2020; Briceño-Iragorry, 2020; Carrillo-Esper, Jacinto-Flores, Melgar-Bieberach, Tapia-Salazar, & Campa-Mendoza, 2021; Collado-Chagoya, Hernández-Romero, Cruz-Pantoja, & Velasco-Medina et al., 2021; Del Carpio-Orantes, González-Segovia, Mojica-Ríos, & Suárez-Mandujano, 2020; García-Regalado, Brugada-Molina, Montalvo-Aguilar, & MartínezPantoja AC, 2020; García-Villarreal & Palacios-Mendoza, 2021; Ibarra-Morales, Pérez-Leal, & Jiménez-Mendoza, 2020; Maradiaga-Montoya, Izaguirre, & Sánchez, 2021; Márquez-Quiroz, Flores-Barrientos, & Gónzales-Romo, 2020; Martínez-Hernández, López-Enríquez, Piedras-Hernández, Salinas-Herrera, & Galván-Salazar, 2021; Ordonez-Espinosa, Gallardo-Hernan- dez, Hernandez-Perez, & Revilla- Monsalve, 2020; Ovilla-Martínez, De la Peña-Celaya, Báez-Islas, & Del Bosque-Patoni, 2020; Pérez-López & Moreno-Madrigal, 2021; Ramírez-Gil & Montiel-López, 2020; Roig-Marín, Roig-Rico, Banon-Escandel, & Segui-Ripoll et al., 2021; Roig-Marín, Roig-Rico, Delgado-Sanchez, & Segui-Ripoll, 2021) in which patients had a febrile syndrome as a defense mechanism against the infectious process, such as that produced by SARS-CoV-2.
Safety profile of COVID-19 vaccines, preventive strategies, and patient management
Published in Expert Review of Vaccines, 2022
M. Mukhyaprana Prabhu, Subish Palaian, Mukhtar Ansari
Fever is quite common after vaccination. It is advisable to take paracetamol or ibuprofen to manage fever. Informed consent with a risk-benefit ratio advised for high-risk population (e.g. with history of allergy, immunocompromised individuals, those on immunosuppressive therapy, cancer patients on chemotherapy, pregnant, and lactating women). Special education regarding rare ADRs like VITT presentation and neurological demyelination should be provided for both vaccine recipients and health professionals. The patients should be able to recognize and report to health workers without any delay if they experience severe headache, pain in abdomen, chest pain, breathlessness, and bleeding, which are considered early warning symptoms of VITT. Similarly, symptoms such as weakness, numbness, and urinary disturbances may alert an impending neurological complication of the vaccine. Early clinical diagnosis by a physician can certainly help reducing fatalities. Minor side effects can be managed by NSAIDs and antipyretics, antihistamines, and hydration in consultation with a local physician. Serious ADRs like anaphylaxis, VITT, and demyelination need hospitalization and specialized treatment. Immunocompromised patients (HIV-positive and those on immunosuppressive treatment and chemotherapy) may not develop full immunogenic response. Other COVID-19 measures such as wearing mask, safe distancing, and hand sanitization measures should be continued even after complete vaccination. Public should be made aware on the local guidelines on social distancing, use of face mask, etc. and should adhere strictly.
Related Knowledge Centers
- Body Temperature
- Febrile Seizure
- Lethality
- Perspiration
- Thermoregulation
- Muscle Tone
- Hypothalamus
- Body Temperature
- Chills
- Flushing
- Viral Disease